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General NPI Number Information
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NPI Number | 1366957631
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Entity Type | Organization
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Legal Business Name | JONATHAN DELA LUNA, MD, LLC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 2180 MENDON RD STE 21
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City | CUMBERLAND
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State | RI
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Zip | 02864-3825
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Country | US
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Telephone | 401-333-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 2180 MENDON RD STE 21
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City | CUMBERLAND
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State | RI
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Zip | 02864-3825
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Country | US
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Telephone | 401-333-3810
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JONATHAN VILLAS DELA LUNA
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Credential | MD
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Telephone | 401-333-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD14529
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License Number State | RI
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